Endometrial ablation devices and systems

ABSTRACT

Systems and methods for endometrial ablation. The systems include a handle and elongated introducer sleeve extending to an expandable working end having a fluid-tight interior chamber. A thin dielectric wall surrounds at least a portion of the interior chamber and has an external surface for contacting endometrial tissue. The thin dielectric wall surrounds a collapsible-expandable frame and receives an electrically non-conductive gas. First and second polarity electrodes are exposed to the interior and exterior of the chamber, respectively. A radiofrequency power source operatively connects to the electrode arrangement to apply a radiofrequency voltage across the first and second electrodes, wherein the voltage is sufficient to initiate ionization of the neutral gas into a conductive plasma within the interior chamber, and to capacitively couple the current in the plasma across the thin dielectric wall to ablate endometrial tissue engaged by the external surface of the dielectric structure.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.12/605,546 (Attorney Docket No. 37644-704.501), filed Oct. 26, 2009,which is a continuation in part of U.S. application Ser. No. 12/541,043,(Attorney Docket No. 37644-703.201), filed Aug. 13, 2009, now U.S. Pat.No. 8,372,068, and U.S. application Ser. No. 12/541,050 (Attorney DocketNo. 37644-703.202), filed on Aug. 13, 2009, now U.S. Pat. No. 8,382,753,both of which claim the benefit of provisional Application No.61/196,870 (Attorney Docket No. 37644-703.101), filed on Oct. 21, 2008,the full disclosures of which are incorporated herein by reference.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to electrosurgical methods and devices forglobal endometrial ablation in a treatment of menorrhagia. Moreparticularly, the present invention relates to applying radiofrequencycurrent to endometrial tissue by means of capacitively coupling thecurrent through an expandable, thin-wall dielectric member enclosing anionized gas.

A variety of devices have been developed or proposed for endometrialablation. Of relevance to the present invention, a variety ofradiofrequency ablation devices have been proposed including solidelectrodes, balloon electrodes, metalized fabric electrodes, and thelike. While often effective, many of the prior electrode designs havesuffered from one or more deficiencies, such as relatively slowtreatment times, incomplete treatments, non-uniform ablation depths, andrisk of injury to adjacent organs.

For these reasons, it would be desirable to provide systems and methodsthat allow for endometrial ablation using radiofrequency current whichis rapid, provides for controlled ablation depth and which reduce therisk of injury to adjacent organs. At least some of these objectiveswill be met by the invention described herein.

2. Description of the Background Art

U.S. Pat. Nos. 5,769,880; 6,296,639; 6,663,626; and 6,813,520 describeintrauterine ablation devices formed from a permeable mesh definingelectrodes for the application of radiofrequency energy to ablateuterine tissue. U.S. Pat. No. 4,979,948 describes a balloon filled withan electrolyte solution for applying radiofrequency current to a mucosallayer via capacitive coupling. US 2008/097425, having commoninventorship with the present application, describes delivering apressurized flow of a liquid medium which carries a radiofrequencycurrent to tissue, where the liquid is ignited into a plasma as itpasses through flow orifices. U.S. Pat. No. 5,891,134 describes aradiofrequency heater within an enclosed balloon. U.S. Pat. No.6,041,260 describes radiofrequency electrodes distributed over theexterior surface of a balloon which is inflated in a body cavity to betreated. U.S. Pat. No. 7,371,231 and US 2009/054892 describe aconductive balloon having an exterior surface which acts as an electrodefor performing endometrial ablation. U.S. Pat. No. 5,191,883 describesbipolar heating of a medium within a balloon for thermal ablation. U.S.Pat. No. 6,736,811 and U.S. Pat. No. 5,925,038 show an inflatableconductive electrode.

BRIEF SUMMARY OF THE INVENTION

The present invention provides a systems and methods for endometrialablation, which relate to method and apparatus disclosed in U.S.application Ser. No. 12/541,043; filed Aug. 13, 2009 (Atty. Docket No.027980-000110US) and U.S. application Ser. No. 12/541,050 (Atty. DocketNo. 027980-000120US) both filed on Aug. 13, 2009, the full disclosuresof which are incorporated herein by reference. The systems fordelivering radiofrequency current to tissue comprises a handle andelongated introducer sleeve extending to an expandable working endhaving a fluid-tight interior chamber. A thin dielectric wall surroundsat least a portion of the interior chamber and has an external surfacefor contacting endometrial tissue. The thin dielectric wall surrounds acollapsible-expandable frame. A gas inflow lumen and a gas outflow lumenare provided to communicate with the interior chamber for delivering aflow of an electrically non-conductive gas into and through the chamber.A first polarity electrode is provided which has a surface exposed tothe interior chamber. A second polarity electrode exterior of theinterior chamber is also provided that includes a surface adapted tocontact body tissue. The system further includes a radiofrequency powersource operatively connected to the electrode arrangement to apply aradiofrequency voltage across the first and second electrodes, whereinthe voltage is sufficient to initiate ionization of the neutral gas intoa conductive plasma within the interior chamber. The voltage further issufficient to capacitively couple the current in the plasma across thethin dielectric wall and into endometrial tissue engaged by the externalsurface of the dielectric structure. The treatment method generallycomprises delivering a radiofrequency current to endometrial tissue inorder to heat and usually ablate the tissue to a desired depth, rangingfrom about 2 to 6 mm.

In one embodiment, the thin dielectric wall can comprise a conformablematerial, typically a silicone. A conformable dielectric wall can have athickness in the range from about 0.005″ to 0.020″, usually from 0.008″to 0.010″. The conformable wall may be non-distensible or may be elasticso that the wall structure may be expanded. For either non-distensibleor elastic dielectric walls, the device may further comprise a framewhich supports the conformable material, usually where the frame can beexpanded and contracted to open and close the dielectric wall.

The hand-held device of the invention typically comprises a probe withan elongated introducer sleeve and a handle for actuating thecollapsible-expandable frame to expand the thin dielectric wall in auterine cavity. The introducer sleeve typically has a bore therein tohouse the thin-wall dielectric structure as the sleeve is introducedinto the uterine cavity. The system further includes a controller forcontrolling the circulation of gas in a continuous flow through theinterior chamber.

The radiofrequency power source is of the type used in electrosurgery,and will typically be configured to deliver a voltage in the range from500 V (rms) to 2500 V (rms), usually from 600 V (rms) to 1200V (rms),typically at a current in the range from 0.1 A to 1 A, typically from0.2 A to 0.5 A, and at a frequency in the range from 450 kHz to 550 kHz,usually from 480 kHz to 500 kHz.

The electrically non-conductive gas that is provided in a gas flowthrough the interior chamber can be provided from a disposablecompressed gas cartridge. The flow rate of a non-conductive gas, such asargon, will typically be in the range from about 5 ml/sec to 50 ml/sec,preferably from 10 ml/sec to 30 ml/sec.

In an embodiment, a system for endometrial ablation is provided,comprising a thin dielectric wall at least partially surrounding aninterior chamber and having a shape for positioning in a uterine cavity;a gas source configured to deliver a non-conductive gas into theinterior chamber; a first polarity electrode exposed to the interiorchamber; a second polarity electrode external to the interior chamberfor contacting patient tissue; and a radiofrequency energy sourcecoupled to the first and second polarity electrodes for providing avoltage sufficient to convert the non-conductive gas to a plasma and tocapacitively couple current across the dielectric wall to endometrialtissue.

The dielectric wall may have a triangular configuration for contactingendometrial tissue about the uterine cavity. The dielectric wall maycomprise a distensible material or a non-distensible material, and maybe formed, for example, from silicone.

In embodiments, the dielectric wall has a thickness in the range from0.005 inches to 0.020 inches. The dielectric wall may be capable ofcontracted and expanded shapes.

A support structure may be provided in the interior chamber that iscapable of contracted and expanded shapes. The support structure mayinclude spring elements to bias the dielectric wall toward an expandedshape. The first polarity electrode may comprise at least a portion ofthe support structure.

An elongated introducer can be connected to the dielectric wall andsupport structure. The second polarity electrode can be carried by theintroducer. In other embodiments, the second polarity electrode can becarried on an exterior surface of the dielectric wall.

The introducer may include at least two lumens in the introducercommunicating with the interior chamber for providing a gas inflow fromthe gas source and a gas outflow out of the interior chamber,respectively. The gas source can comprise a remote gas source coupled toone of the two lumens in the introducer for providing the gas inflowinto the interior chamber. A controller can be operatively coupled tothe gas source for controlling gas inflow. The gas source can comprise agas source coupled to one of the two lumens in the introducer forproviding a gas inflow into the interior chamber. A controller can beoperatively coupled to the vacuum source for controlling gas outflow.

In embodiments, the interior chamber has a volume in the range from 1 mlto 10 ml. The radiofrequency energy source is, for example, configuredto deliver in the range from 500V to 2500V.

In embodiments, an endometrial ablation device is provided comprising anelongated introducer having a handle end and a working end; anexpandable dielectric wall carried at the working end, defining aninterior chamber, and configured, when expanded, to contact endometrialtissue; a gas source for flowing a neutral gas into the interiorchamber; and first and second polarity electrodes disposed internal andexternal to the interior chamber, respectively. When the dielectric wallis expanded to contact endometrial tissue, application of aradiofrequency voltage across the first and second polarity electrodeswhen a neutral gas is within the interior chamber causes a plasma toform and capacitively couple current across the dielectric wall toablate endometrial tissue.

In embodiments, the first polarity electrode comprises a portion of asupport structure for supporting the dielectric wall in an expandedshape. The second polarity electrode may comprise an exterior surfaceportion of the dielectric wall, or a portion of the introducer, asexamples.

The gas source may be configured to circulate gas through the interiorchamber, or configured to provide a flow of neutral gas into theinterior chamber, as examples.

A flow rate of the neutral gas into the interior chamber may be withinthe range from 0.05 ml/sec to 50 ml/sec. The gas source is configured topermit the flow of at least one of the neutral gas and the plasma out ofthe interior chamber.

The device may include an expandable frame for expanding the dielectricwall. In embodiments, the frame supports the dielectric wall. Theexpandable frame comprises the first polarity electrode.

The second polarity electrode can be carried on an exterior surface ofthe dielectric wall. The dielectric wall may have, for example, atriangular configuration for contacting endometrial tissue about theuterine cavity. The dielectric wall may comprises a distensible materialor a non-distensible material. The dielectric wall comprises, forexample, a silicone.

The dielectric wall may, for example, a thickness in the range from0.005 inches to 0.020 inches. The dielectric wall may be capable ofcontracted and expanded shapes. An expandable member may be mounted tothe introducer for sealing the cervical canal of the patient. Theexpandable member may comprise a balloon.

BRIEF DESCRIPTION OF THE DRAWINGS

In order to better understand the invention and to see how it may becarried out in practice, some preferred embodiments are next described,by way of non-limiting examples only, with reference to the accompanyingdrawings, in which like reference characters denote correspondingfeatures consistently throughout similar embodiments in the attacheddrawings.

FIG. 1 is a perspective view of an ablation system corresponding to theinvention, including a hand-held electrosurgical device for endometrialablation, RF power source, gas source and controller.

FIG. 2 is a view of the hand-held electrosurgical device of FIG. 1 witha deployed, expanded thin-wall dielectric structure.

FIG. 3 is a block diagram of components of one electrosurgical systemcorresponding to the invention.

FIG. 4 s a block diagram of the gas flow components of theelectrosurgical system of FIG. 1.

FIG. 5 is an enlarged perspective view of the expanded thin-walldielectric structure, showing an expandable-collapsible frame with thethin dielectric wall in phantom view.

FIG. 6 is a partial sectional view of the expanded thin-wall dielectricstructure of FIG. 5 showing (i) translatable members of theexpandable-collapsible frame a that move the structure between collapsedand (ii) gas inflow and outflow lumens.

FIG. 7 is a sectional view of an introducer sleeve showing variouslumens of the introducer sleeve taken along line 7-7 of FIG. 6.

FIG. 8A is an enlarged schematic view of an aspect of a method of theinvention illustrating the step introducing an introducer sleeve into apatient's uterus.

FIG. 8B is a schematic view of a subsequent step of retracting theintroducer sleeve to expose a collapsed thin-wall dielectric structureand internal frame in the uterine cavity.

FIG. 8C is a schematic view of subsequent steps of the method,including, (i) actuating the internal frame to move the a collapsedthin-wall dielectric structure to an expanded configuration, (ii)inflating a cervical-sealing balloon carried on the introducer sleeve,and (iii) actuating gas flows and applying RF energy tocontemporaneously ionize the gas in the interior chamber and causecapacitive coupling of current through the thin-wall dielectricstructure to cause ohmic heating in the engaged tissue indicated bycurrent flow paths.

FIG. 8D is a schematic view of a subsequent steps of the method,including: (i) advancing the introducer sleeve over the thin-walldielectric structure to collapse it into an interior bore shown inphantom view, and (ii) withdrawing the introducer sleeve and dielectricstructure from the uterine cavity.

FIG. 9 is a cut-away perspective view of an alternative expandedthin-wall dielectric structure similar to that of FIGS. 5 and 6 show analternative electrode configuration.

FIG. 10 is an enlarged cut-away view of a portion of the expandedthin-wall dielectric structure of FIG. 9 showing the electrodeconfiguration.

DETAILED DESCRIPTION OF THE INVENTION

In general, an electrosurgical ablation system is described herein thatcomprises an elongated introducer member for accessing a patient'suterine cavity with a working end that deploys an expandable thin-walldielectric structure containing an electrically non-conductive gas as adielectric. In one embodiment, an interior chamber of the thin-walldielectric structure contains a circulating neutral gas such as argon.An RF power source provides current that is coupled to the neutral gasflow by a first polarity electrode disposed within the interior chamberand a second polarity electrode at an exterior of the working end. Thegas flow, which is converted to a conductive plasma by an electrodearrangement, functions as a switching mechanism that permits currentflow to engaged endometrial tissue only when the voltage across thecombination of the gas, the thin-wall dielectric structure and theengaged tissue reaches a threshold that causes capacitive couplingacross the thin-wall dielectric material. By capacitively couplingcurrent to tissue in this manner, the system provides a substantiallyuniform tissue effect within all tissue in contact with the expandeddielectric structure. Further, the invention allows the neutral gas tobe created contemporaneously with the capacitive coupling of current totissue.

In general, this disclosure may use the terms “plasma”, “conductive gas”and “ionized gas” interchangeably. A plasma consists of a state ofmatter in which electrons in a neutral gas are stripped or “ionized”from their molecules or atoms. Such plasmas can be formed by applicationof an electric field or by high temperatures. In a neutral gas,electrical conductivity is non-existent or very low. Neutral gases actas a dielectric or insulator until the electric field reaches abreakdown value, freeing the electrons from the atoms in an avalancheprocess thus forming a plasma. Such a plasma provides mobile electronsand positive ions, and acts as a conductor which supports electriccurrents and can form spark or arc. Due to their lower mass, theelectrons in a plasma accelerate more quickly in response to an electricfield than the heavier positive ions, and hence carry the bulk of thecurrent.

FIG. 1 depicts one embodiment of an electrosurgical ablation system 100configured for endometrial ablation. The system 100 includes a hand-heldapparatus 105 with a proximal handle 106 shaped for grasping with ahuman hand that is coupled to an elongated introducer sleeve 110 havingaxis 111 that extends to a distal end 112. The introducer sleeve 110 canbe fabricated of a thin-wall plastic, composite, ceramic or metal in around or oval cross-section having a diameter or major axis ranging fromabout 4 mm to 8 mm in at least a distal portion of the sleeve thataccesses the uterine cavity. The handle 106 is fabricated of anelectrically insulative material such as a molded plastic with apistol-grip having first and second portions, 114 a and 114 b, that canbe squeezed toward one another to translate an elongated translatablesleeve 115 which is housed in a bore 120 in the elongated introducersleeve 110. By actuating the first and second handle portions, 114 a and114 b, a working end 122 can be deployed from a first retracted position(FIG. 1) in the distal portion of bore 120 in introducer sleeve 110 toan extended position as shown in FIG. 2. In FIG. 2, it can be seen thatthe first and second handle portions, 114 a and 114 b, are in a secondactuated position with the working end 122 deployed from the bore 120 inintroducer sleeve 110.

FIGS. 2 and 3 shows that ablation system 100 includes an RF energysource 130A and RF controller 130B in a control unit 135. The RF energysource 130A is connected to the hand-held device 105 by a flexibleconduit 136 with a plug-in connector 137 configured with a gas inflowchannel, a gas outflow channel, and first and second electrical leadsfor connecting to receiving connector 138 in the control unit 135. Thecontrol unit 135, as will be described further below in FIGS. 3 and 4,further comprises a neutral gas inflow source 140A, gas flow controller140B and optional vacuum or negative pressure source 145 to providecontrolled gas inflows and gas outflows to and from the working end 122.The control unit 135 further includes a balloon inflation source 148 forinflating an expandable sealing balloon 225 carried on introducer sleeve110 as described further below.

Referring to FIG. 2, the working end 122 includes a flexible, thin-wallmember or structure 150 of a dielectric material that when expanded hasa triangular shape configured for contacting the patient's endometriallining that is targeted for ablation. In one embodiment as shown inFIGS. 2, 5 and 6, the dielectric structure 150 comprises a thin-wallmaterial such as silicone with a fluid-tight interior chamber 152.

In an embodiment, an expandable-collapsible frame assembly 155 isdisposed in the interior chamber. Alternatively, the dielectricstructure may be expanded by a neutral gas without a frame, but using aframe offers a number of advantages. First, the uterine cavity isflattened with the opposing walls in contact with one another. Expandinga balloon-type member may cause undesirable pain or spasms. For thisreason, a flat structure that is expanded by a frame is better suitedfor deployment in the uterine cavity. Second, in embodiments herein, theneutral gas is converted to a conductive plasma at a very low pressurecontrolled by gas inflows and gas outflows—so that any pressurization ofa balloon-type member with the neutral gas may exceed a desired pressurerange and would require complex controls of gas inflows and gasoutflows. Third, as described below, the frame provides an electrode forcontact with the neutral gas in the interior chamber 152 of thedielectric structure 150, and the frame 155 extends into all regions ofthe interior chamber to insure electrode exposure to all regions of theneutral gas and plasma. The frame 155 can be constructed of any flexiblematerial with at least portions of the frame functioning as springelements to move the thin-wall structure 150 from a collapsedconfiguration (FIG. 1) to an expanded, deployed configuration (FIG. 2)in a patient's uterine cavity. In one embodiment, the frame 155comprises stainless steel elements 158 a, 158 b and 160 a and 160 b thatfunction akin to leaf springs. The frame can be a stainless steel suchas 316 SS, 17A SS, 420 SS, 440 SS or the frame can be a NiTi material.The frame preferably extends along a single plane, yet remains thintransverse to the plane, so that the frame may expand into the uterinecavity. The frame elements can have a thickness ranging from about0.005″ to 0.025″. As can be seen in FIGS. 5 and 6, the proximal ends 162a and 162 b of spring elements 158 a, 158 b are fixed (e.g., by welds164) to the distal end 165 of sleeve member 115. The proximal ends 166 aand 166 b of spring elements 160 a, 160 b are welded to distal portion168 of a secondary translatable sleeve 170 that can be extended frombore 175 in translatable sleeve 115. The secondary translatable sleeve170 is dimensioned for a loose fit in bore 175 to allow gas flows withinbore 175. FIGS. 5 and 6 further illustrate the distal ends 176 a and 176b of spring elements 158 a, 158 b are welded to distal ends 178 a and178 b of spring elements 160 a and 160 b to thus provide a frame 155that can be moved from a linear shape (see FIG. 1) to an expandedtriangular shape (FIGS. 5 and 6).

As will be described further below, the bore 175 in sleeve 115 and bore180 in secondary translatable sleeve 170 function as gas outflow and gasinflow lumens, respectively. It should be appreciated that the gasinflow lumen can comprise any single lumen or plurality of lumens ineither sleeve 115 or sleeve 170 or another sleeve, or other parts of theframe 155 or the at least one gas flow lumen can be formed into a wallof dielectric structure 150. In FIGS. 5, 6 and 7 it can be seen that gasinflows are provided through bore 180 in sleeve 170, and gas outflowsare provided in bore 175 of sleeve 115. However, the inflows andoutflows can be also be reversed between bores 175 and 180 of thevarious sleeves. FIGS. 5 and 6 further show that a rounded bumperelement 185 is provided at the distal end of sleeve 170 to insure thatno sharp edges of the distal end of sleeve 170 can contact the inside ofthe thin dielectric wall 150. In one embodiment, the bumper element 185is silicone, but it could also comprise a rounded metal element. FIGS. 5and 6 also show that a plurality of gas inflow ports 188 can be providedalong a length of in sleeve 170 in chamber 152, as well as a port 190 inthe distal end of sleeve 170 and bumper element 185. The sectional viewof FIG. 7 also shows the gas flow passageways within the interior ofintroducer sleeve 110.

It can be understood from FIGS. 1, 2, 5 and 6 that actuation of firstand second handle portions, 114 a and 114 b, (i) initially causesmovement of the assembly of sleeves 115 and 170 relative to bore 120 ofintroducer sleeve 110, and (ii) secondarily causes extension of sleeve170 from bore 175 in sleeve 115 to expand the frame 155 into thetriangular shape of FIG. 5. The dimensions of the triangular shape aresuited for a patient uterine cavity, and for example can have an axiallength A ranging from 4 to 10 cm and a maximum width B at the distal endranging from about 2 to 5 cm. In one embodiment, the thickness C of thethin-wall structure 150 can be from 1 to 4 mm as determined by thedimensions of spring elements 158 a, 158 b, 160 a and 160 b of frameassembly 155. It should be appreciated that the frame assembly 155 cancomprise round wire elements, flat spring elements, of any suitablemetal or polymer that can provide opening forces to move thin-wallstructure 150 from a collapsed configuration to an expandedconfiguration within the patient uterus. Alternatively, some elements ofthe frame 155 can be spring elements and some elements can be flexiblewithout inherent spring characteristics.

As will be described below, the working end embodiment of FIGS. 2, 5 and6 has a thin-wall structure 150 that is formed of a dielectric materialsuch as silicone that permits capacitive coupling of current to engagedtissue while the frame assembly 155 provides structural support toposition the thin-wall structure 150 against tissue. Further, gasinflows into the interior chamber 152 of the thin-wall structure canassist in supporting the dielectric wall so as to contact endometrialtissue. The dielectric thin-wall structure 150 can be free from fixationto the frame assembly 155, or can be bonded to an outward-facing portionor portions of frame elements 158 a and 158 b. The proximal end 182 ofthin-wall structure 150 is bonded to the exterior of the distal end ofsleeve 115 to thus provide a sealed, fluid-tight interior chamber 152(FIG. 5).

In one embodiment, the gas inflow source 140A comprises one or morecompressed gas cartridges that communicate with flexible conduit 136through plug-in connector 137 and receiving connector 138 in the controlunit 135 (FIGS. 1-2). As can be seen in FIGS. 5-6, the gas inflows fromsource 140A flow through bore 180 in sleeve 170 to open terminations 188and 190 therein to flow into interior chamber 152. A vacuum source 145is connected through conduit 136 and connector 137 to allow circulationof gas flow through the interior chamber 152 of the thin-wall dielectricstructure 150. In FIGS. 5 and 6, it can be seen that gas outflowscommunicate with vacuum source 145 through open end 200 of bore 175 insleeve 115. Referring to FIG. 5, it can be seen that frame elements 158a and 158 b are configured with a plurality of apertures 202 to allowfor gas flows through all interior portions of the frame elements, andthus gas inflows from open terminations 188, 190 in bore 180 are free tocirculated through interior chamber 152 to return to an outflow paththrough open end 200 of bore 175 of sleeve 115. As will be describedbelow (see FIGS. 3-4), the gas inflow source 140A is connected to a gasflow or circulation controller 140B which controls a pressure regulator205 and also controls vacuum source 145 which is adapted for assistingin circulation of the gas. It should be appreciated that the frameelements can be configured with apertures, notched edges or any otherconfigurations that allow for effective circulation of a gas throughinterior chamber 152 of the thin-wall structure 150 between the inflowand outflow passageways.

Now turning to the electrosurgical aspects of the invention, FIGS. 5 and6 illustrate opposing polarity electrodes of the system 100 that areconfigured to convert a flow of neutral gas in chamber 152 into a plasma208 (FIG. 6) and to allow capacitive coupling of current through a wall210 of the thin-wall dielectric structure 150 to endometrial tissue incontact with the wall 210. The electrosurgical methods of capacitivelycoupling RF current across a plasma 208 and dielectric wall 210 aredescribed in U.S. patent application Ser. No. 12/541,043; filed Aug. 13,2009 (Atty. Docket No. 027980-000110US) and U.S. application Ser. No.12/541,050 (Atty. Docket No. 027980-000120US), referenced above. InFIGS. 5 and 6, the first polarity electrode 215 is within interiorchamber 152 to contact the neutral gas flow and comprises the frameassembly 155 that is fabricated of an electrically conductive stainlesssteel. In another embodiment, the first polarity electrode can be anyelement disposed within the interior chamber 152, or extendable intointerior chamber 152. The first polarity electrode 215 is electricallycoupled to sleeves 115 and 170 which extends through the introducersleeve 110 to handle 106 and conduit 136 and is connected to a firstpole of the RF source energy source 130A and controller 130B. A secondpolarity electrode 220 is external of the internal chamber 152 and inone embodiment the electrode is spaced apart from wall 210 of thethin-wall dielectric structure 150. In one embodiment as depicted inFIGS. 5 and 6, the second polarity electrode 220 comprises a surfaceelement of an expandable balloon member 225 carried by introducer sleeve110. The second polarity electrode 220 is coupled by a lead (not shown)that extends through the introducer sleeve 110 and conduit 136 to asecond pole of the RF source 130A. It should be appreciated that secondpolarity electrode 220 can be positioned on sleeve 110 or can beattached to surface portions of the expandable thin-wall dielectricstructure 150, as will be described below, to provide suitable contactwith body tissue to allow the electrosurgical ablation of the method ofthe invention. The second polarity electrode 220 can comprise a thinconductive metallic film, thin metal wires, a conductive flexiblepolymer or a polymeric positive temperature coefficient material. In oneembodiment depicted in FIGS. 5 and 6, the expandable member 225comprises a thin-wall compliant balloon having a length of about 1 cm to6 cm that can be expanded to seal the cervical canal. The balloon 225can be inflated with a gas or liquid by any inflation source 148, andcan comprise a syringe mechanism controlled manually or by control unit135. The balloon inflation source 148 is in fluid communication with aninflation lumen 228 in introducer sleeve 110 that extends to aninflation chamber of balloon 225 (see FIG. 7).

Referring back to FIG. 1, the control unit 135 can include a display 230and touchscreen or other controls 232 for setting and controllingoperational parameters such as treatment time intervals, treatmentalgorithms, gas flows, power levels and the like. Suitable gases for usein the system include argon, other noble gases and mixtures thereof. Inone embodiment, a footswitch 235 is coupled to the control unit 135 foractuating the system.

The box diagrams of FIGS. 3 and 4 schematically depict the system 100,subsystems and components that are configured for an endometrialablation system. In the box diagram of FIG. 3, it can be seen that RFenergy source 130A and circuitry is controlled by a controller 130B. Thesystem can include feedback control systems that include signalsrelating to operating parameters of the plasma in interior chamber 152of the dielectric structure 150. For example, feedback signals can beprovided from at least one temperature sensor 240 in the interiorchamber 152 of the dielectric structure 150, from a pressure sensorwithin, or in communication, with interior chamber 152, and/or from agas flow rate sensor in an inflow or outflow channel of the system. FIG.4 is a schematic block diagram of the flow control components relatingto the flow of gas media through the system 100 and hand-held device105. It can be seen that a pressurized gas source 140A is linked to adownstream pressure regulator 205, an inflow proportional valve 246,flow meter 248 and normally closed solenoid valve 250. The valve 250 isactuated by the system operator which then allows a flow of a neutralgas from gas source 140A to circulate through flexible conduit 136 andthe device 105. The gas outflow side of the system includes a normallyopen solenoid valve 260, outflow proportional valve 262 and flowmeter264 that communicate with vacuum pump or source 145. The gas can beexhausted into the environment or into a containment system. Atemperature sensor 270 (e.g., thermocouple) is shown in FIG. 4 that isconfigured for monitoring the temperature of outflow gases. FIG. 4further depicts an optional subsystem 275 which comprises a vacuumsource 280 and solenoid valve 285 coupled to the controller 140B forsuctioning steam from a uterine cavity 302 at an exterior of thedielectric structure 150 during a treatment interval. As can beunderstood from FIG. 4, the flow passageway from the uterine cavity 302can be through bore 120 in sleeve 110 (see FIGS. 2, 6 and 7) or anotherlumen in a wall of sleeve 110 can be provided.

FIGS. 8A-8D schematically illustrate a method of the invention wherein(i) the thin-wall dielectric structure 150 is deployed within a patientuterus and (ii) RF current is applied to a contained neutral gas volumein the interior chamber 152 to contemporaneously create a plasma 208 inthe chamber and capacitively couple current through the thin dielectricwall 210 to apply ablative energy to the endometrial lining toaccomplish global endometrial ablation.

More in particular, FIG. 8A illustrates a patient uterus 300 withuterine cavity 302 surrounded by endometrium 306 and myometrium 310. Theexternal cervical os 312 is the opening of the cervix 314 into thevagina 316. The internal os or opening 320 is a region of the cervicalcanal that opens to the uterine cavity 302. FIG. 8A depicts a first stepof a method of the invention wherein the physician has introduced adistal portion of sleeve 110 into the uterine cavity 302. The physiciangently can advance the sleeve 110 until its distal tip contacts thefundus 324 of the uterus. Prior to insertion of the device, thephysician can optionally introduce a sounding instrument into theuterine cavity to determine uterine dimensions, for example from theinternal os 320 to fundus 324.

FIG. 8B illustrates a subsequent step of a method of the inventionwherein the physician begins to actuate the first and second handleportions, 114 a and 114 b, and the introducer sleeve 110 retracts in theproximal direction to expose the collapsed frame 155 and thin-wallstructure 150 within the uterine cavity 302. The sleeve 110 can beretracted to expose a selected axial length of thin-wall dielectricstructure 150, which can be determined by markings 330 on sleeve 115(see FIG. 1) which indicate the axial travel of sleeve 115 relative tosleeve 170 and thus directly related to the length of deployed thin-wallstructure 150. FIG. 2 depicts the handle portions 114 a and 114 b fullyapproximated thus deploying the thin-wall structure to its maximumlength.

FIG. 8C illustrates several subsequent steps of a method of theinvention. FIG. 8C first depicts the physician continuing to actuate thefirst and second handle portions, 114 a and 114 b, which furtheractuates the frame 155 (see FIGS. 5-6) to expand the frame 155 andthin-wall structure 150 to a deployed triangular shape to contact thepatient's endometrial lining 306. The physician can slightly rotate andmove the expanding dielectric structure 150 back and forth as thestructure is opened to insure it is opened to the desired extent. Inperforming this step, the physician can actuate handle portions, 114 aand 114 b, a selected degree which causes a select length of travel ofsleeve 170 relative to sleeve 115 which in turn opens the frame 155 to aselected degree. The selected actuation of sleeve 170 relative to sleeve115 also controls the length of dielectric structure deployed fromsleeve 110 into the uterine cavity. Thus, the thin-wall structure 150can be deployed in the uterine cavity with a selected length, and thespring force of the elements of frame 155 will open the structure 150 toa selected triangular shape to contact or engage the endometrium 306. Inone embodiment, the expandable thin-wall structure 150 is urged towardand maintained in an open position by the spring force of elements ofthe frame 155. In the embodiment depicted in FIGS. 1 and 2, the handle106 includes a locking mechanism with finger-actuated sliders 332 oneither side of the handle that engage a grip-lock element against anotch in housing 333 coupled to introducer sleeve 110 (FIG. 2) to locksleeves 115 and 170 relative to introducer sleeve 110 to maintain thethin-wall dielectric structure 150 in the selected open position.

FIG. 8C further illustrates the physician expanding the expandableballoon structure 225 from inflation source 148 to thus provide anelongated sealing member to seal the cervix 314 outward from theinternal os 320. Following deployment of the thin-wall structure 150 andballoon 225 in the cervix 314, the system 100 is ready for theapplication of RF energy to ablate endometrial tissue 306. FIG. 8C nextdepicts the actuation of the system 100, for example, by actuatingfootswitch 235, which commences a flow of neutral gas from source 140Ainto the interior chamber 152 of the thin-wall dielectric structure 150.Contemporaneous with, or after a selected delay, the system's actuationdelivers RF energy to the electrode arrangement which includes firstpolarity electrode 215 (+) of frame 155 and the second polarityelectrode 220 (−) which is carried on the surface of expandable balloonmember 225. The delivery of RF energy delivery will instantly convertthe neutral gas in interior chamber 152 into conductive plasma 208 whichin turn results in capacitive coupling of current through the dielectricwall 210 of the thin-wall structure 150 resulting in ohmic heating ofthe engaged tissue. FIG. 8C schematically illustrates the multiplicityof RF current paths 350 between the plasma 208 and the second polarityelectrode 220 through the dielectric wall 210. By this method, it hasbeen found that ablation depths of three mm to six mm or more can beaccomplished very rapidly, for example in 60 seconds to 120 secondsdependent upon the selected voltage and other operating parameters. Inoperation, the voltage at which the neutral gas inflow, such as argon,becomes conductive (i.e., converted in part into a plasma) is dependentupon a number of factors controlled by the controllers 130B and 140B,including the pressure of the neutral gas, the volume of interiorchamber 152, the flow rate of the gas through the chamber 152, thedistance between electrode 210 and interior surfaces of the dielectricwall 210, the dielectric constant of the dielectric wall 210 and theselected voltage applied by the RF source 130, all of which can beoptimized by experimentation. In one embodiment, the gas flow rate canbe in the range of 5 ml/sec to 50 ml/sec. The dielectric wall 210 cancomprise a silicone material having a thickness ranging from a 0.005″ to0.015 and having a relative permittivity in the range of 3 to 4. The gascan be argon supplied in a pressurized cartridge which is commerciallyavailable. Pressure in the interior chamber 152 of dielectric structure150 can be maintained between 14 psia and 15 psia with zero or negativedifferential pressure between gas inflow source 140A and negativepressure or vacuum source 145. The controller is configured to maintainthe pressure in interior chamber in a range that varies by less than 10%or less than 5% from a target pressure. The RF power source 130A canhave a frequency of 450 to 550 KHz, and electrical power can be providedwithin the range of 600 Vrms to about 1200 Vrms and about 0.2 Amps to0.4 Amps and an effective power of 40 W to 100 W. In one method, thecontrol unit 135 can be programmed to delivery RF energy for apreselected time interval, for example, between 60 seconds and 120seconds. One aspect of a treatment method corresponding to the inventionconsists of ablating endometrial tissue with RF energy to elevateendometrial tissue to a temperature greater than 45 degrees Celsius fora time interval sufficient to ablate tissue to a depth of at least 1 mm.Another aspect of the method of endometrial ablation of consists ofapplying radiofrequency energy to elevate endometrial tissue to atemperature greater than 45 degrees Celsius without damaging themyometrium.

FIG. 8D illustrates a final step of the method wherein the physiciandeflates the expandable balloon member 225 and then extends sleeve 110distally by actuating the handles 114 a and 114 b to collapse frame 155and then retracting the assembly from the uterine cavity 302.Alternatively, the deployed working end 122 as shown in FIG. 8C can bewithdrawn in the proximal direction from the uterine cavity wherein theframe 155 and thin-wall structure 150 will collapse as it is pulledthrough the cervix. FIG. 8D shows the completed ablation with theablated endometrial tissue indicated at 360.

In another embodiment, the system can include an electrode arrangementin the handle 106 or within the gas inflow channel to pre-ionize theneutral gas flow before it reaches the interior chamber 152. Forexample, the gas inflow channel can be configured with axially orradially spaced apart opposing polarity electrodes configured to ionizethe gas inflow. Such electrodes would be connected in separate circuitryto an RF source. The first and second electrodes 215 (+) and 220 (−)described above would operate as described above to provide the currentthat is capacitively coupled to tissue through the walls of thedielectric structure 150. In all other respects, the system and methodwould function as described above.

Now turning to FIGS. 9 and 10, an alternate working end 122 withthin-wall dielectric structure 150 is shown. In this embodiment, thethin-wall dielectric structure 150 is similar to that of FIGS. 5 and 6except that the second polarity electrode 220′ that is exterior of theinternal chamber 152 is disposed on a surface portion 370 of thethin-wall dielectric structure 150. In this embodiment, the secondpolarity electrode 220′ comprises a thin-film conductive material, suchas gold, that is bonded to the exterior of thin-wall material 210 alongtwo lateral sides 354 of dielectric structure 150. It should beappreciated that the second polarity electrode can comprise one or moreconductive elements disposed on the exterior of wall material 210, andcan extend axially, or transversely to axis 111 and can be singular ormultiple elements. In one embodiment shown in more detail in FIG. 10,the second polarity electrode 220′ can be fixed on another lubriciouslayer 360, such as a polyimide film, for example KAPTON®. The polyimidetape extends about the lateral sides 354 of the dielectric structure 150and provides protection to the wall 210 when it is advanced from orwithdrawn into bore 120 in sleeve 110. In operation, the RF deliverymethod using the embodiment of FIGS. 9 and 10 is the same as describedabove, with RF current being capacitively coupled from the plasma 208through the wall 210 and endometrial tissue to the second polarityelectrode 220′ to cause the ablation.

FIG. 9 further shows an optional temperature sensor 390, such as athermocouple, carried at an exterior of the dielectric structure 150. Inone method of use, the control unit 135 can acquire temperature feedbacksignals from at least one temperature sensor 390 to modulate orterminate RF energy delivery, or to modulate gas flows within thesystem. In a related method of the invention, the control unit 135 canacquire temperature feedback signals from temperature sensor 240 ininterior chamber 152 (FIG. 6 to modulate or terminate RF energy deliveryor to modulate gas flows within the system.

Although particular embodiments of the present invention have beendescribed above in detail, it will be understood that this descriptionis merely for purposes of illustration and the above description of theinvention is not exhaustive. Specific features of the invention areshown in some drawings and not in others, and this is for convenienceonly and any feature may be combined with another in accordance with theinvention. A number of variations and alternatives will be apparent toone having ordinary skills in the art. Such alternatives and variationsare intended to be included within the scope of the claims. Particularfeatures that are presented in dependent claims can be combined and fallwithin the scope of the invention. The invention also encompassesembodiments as if dependent claims were alternatively written in amultiple dependent claim format with reference to other independentclaims.

1. A system for endometrial ablation comprising: a thin dielectric wallat least partially surrounding an interior chamber and having a shapefor positioning in a uterine cavity; a gas source configured to delivera non-conductive gas into the interior chamber; a first polarityelectrode exposed to the interior chamber; a second polarity electrodeexternal to the interior chamber for contacting patient tissue; and aradiofrequency energy source coupled to the first and second polarityelectrodes for providing a voltage sufficient to ionize thenon-conductive gas to produce a conductive gas within the chamber. 2.The system of claim 1, wherein the radiofrequency energy source isconfigured to capacitively couple current across the dielectric wall toendometrial tissue.
 3. The system of claim 1, wherein the first polarityelectrode and the second polaity electrode together act as a switchingmechanism that permits current flow to endometrial tissue only when thevoltage across the combination of the gas, the thin-wall dielectricstructure and the engaged tissue reaches a threshold that causescapacitive coupling across the thin-wall dielectric material.
 4. Thesystem of claim 1, wherein the dielectric wall comprises a distensiblematerial.
 5. The system of claim 1, wherein the dielectric wallcomprises a non-distensible material.
 6. The system of claim 1, whereinthe dielectric wall comprises a silicone.
 7. The system of claim 1,wherein the dielectric wall has a thickness in the range from 0.005inches to 0.020 inches.
 8. The system of claim 1, wherein the dielectricwall is capable of contracted and expanded shapes.
 9. The system ofclaim 1, further comprising a support structure in the interior chambercapable of contracted and expanded shapes.
 10. The system of claim 9,wherein the support structure comprises spring elements to bias thedielectric wall toward an expanded shape.
 11. The system of claim 9,wherein the first polarity electrode comprises at least a portion of thesupport structure.
 12. The system of claim 9, further comprising anelongated introducer connected to the dielectric wall and supportstructure.
 13. The system of claim 12, wherein the second polarityelectrode is carried by the introducer.
 14. The system of claim 12,wherein the second polarity electrode is carried on an exterior surfaceof the dielectric wall.
 15. The system of claim 12, further comprising agas source and at least two lumens in the introducer communicating withthe interior chamber for providing a gas inflow from the gas source anda gas outflow out of the interior chamber, respectively.
 16. The systemof claim 15, wherein the gas source comprises a remote gas sourcecoupled to one of the two lumens in the introducer for providing the gasinflow into the interior chamber.
 17. The system of claim 16, furthercomprising a controller operatively coupled to the gas source forcontrolling gas inflow.
 18. The system of claim 15, wherein the gassource comprises a gas source coupled to one of the two lumens in theintroducer for providing a gas inflow into the interior chamber.
 19. Thesystem of claim 18, further comprising a controller operatively coupledto the vacuum source for controlling gas outflow.
 20. The system ofclaim 1, wherein the interior chamber has a volume in the range from 1ml to 10 ml.
 21. The system of claim 1, wherein the radiofrequencyenergy source is configured to deliver in the range from 500V to 2500V.